Organization
SPACE COAST PAIN RELIEF INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IBEM ROANDLO BORGES M.D. (MEDICAL DIRECTOR)
(321) 269-5533
Entity
Organization
Contact information
Practice address
3550 S WASHINGTON AVE, SUITE 24, TITUSVILLE, FL 32780-8627
(321) 269-5533
(321) 269-3009
Mailing address
3550 S WASHINGTON AVE, SUITE 24, TITUSVILLE, FL 32780-8627
(321) 269-5533
(321) 269-3009
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
ME84507
FL
Other
Enumeration date
03/01/2007
Last updated
08/22/2020
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